Young Women & Breast Cancer

PSYCHO-SOCIAL AND LONG-TERM SURVIVAL ISSUES

In terms of being described as young woman, a generally accepted definition is those who are under 40 years of age. Young women can and do get breast cancer. No young woman is emotionally prepared for the devastating news that a lump in her breast is ‘malignant’. Being diagnosed with breast cancer at any age is a shattering experience, but it is especially difficult at a younger age.

While breast cancer in young women accounts for a small percentage of all breast cancers, the impact of this disease is widespread. In New Zealand, about a quarter of all women diagnosed with breast cancer are under 50- years-old. Around six percent are under the age of 40, while around two percent are under 30.

Being diagnosed with breast cancer at any stage of life is a shattering experience, but it is especially difficult at a younger age. Many women under the age of 40 do not consider breast cancer as a high risk issue and sometimes the diagnosis of cancer is delayed, resulting in more advanced spread of the disease and more radical treatments.

Across the age spectrum, the five year survival rate for breast cancer in New Zealand is 83.5 percent. A majority of women 40 or younger survive their cancer and it is important not to view this diagnosis as a death sentence. We know from a psychological perspective that young women diagnosed with breast cancer face a unique set of challenges than other age groups. On top of the ‘stock standard’ grief, fatigue and anxiety issues associated with the diagnosis - issues not to be taken lightly on their own - are other compounding issues including fertility, partner reaction, dependent children, early onset menopause, sexuality and body image issues.

THE FACTS

International Facts:
• Young women’s cancers tend to be more aggressive
• The five year survival rate for women younger than 40 is worse than women 40-60 years. About 25 percent of women diagnosed with breast cancer are pre-menopausal (and often with motherhood responsibilities).
• They face some issues not faced by post-menopausal women.
• Cancer is more difficult to diagnose in young women.
• They have a lower index of suspicion of malignancy - sometimes delaying diagnosis.
• As a result tumours may be more advanced when diagnosed.
• There is more likely to be a genetic predisposition (e.g. either BRCA1 or BRCA2 gene mutation) in women diagnosed with breast cancer at a young age.
• An inherited gene mutation explains only five percent of breast cancers.
• For young women local recurrence occurs more commonly after breast conserving surgery.
• Breast cancer is diagnosed in about one out of every 3,000 pregnant women.

New Zealand Facts:
• Breast cancer is the most prominent cancer among 25 to 44-year-old females in New Zealand.
• More than 2,500 women are diagnosed with breast cancer each year; that’s around 50 each week.
• One in ten women will be diagnosed with breast cancer in their lifetime.
• One in 67 will be younger than 50 years old.
• One in 204 will be aged between 30 and 39 years old.
• A small proportion will be in their 20’s (or teens).
• Maori and Pacific Island women have a similar incidence of breast cancer than non Maori/Pacific Island, but have higher death rates.

EMOTIONAL IMPACT

The psychological and emotional impacts of a breast cancer diagnosis in young women are profound. Although a diagnosis of cancer at any age is a devastating shock, young women face unique challenges and psychological stressors - notably sadness, loss, anxiety and isolation.

Added to this, a young woman may have the added stress of body image issues (breasts are part of her image and attractiveness), child-rearing and breastfeeding issues, partner reactions, fertility issues, sexuality issues, fatigue, induced menopause and associated effects, anxiety and grief issues.

The importance of supportive counselling through the myriad of unique challenges facing young women cannot be emphasised enough. One of the vexing issues for all women, and especially young women at the time of diagnosis, is that there is little time to decide what course of surgery is most appropriate. Mastectomy, as we know, is a preferred option because of the aggressiveness of cancer in young women. Loss of a breast is one of the most challenging losses a young woman will ever face; however modern reconstructive techniques are very beneficial from a psychological point of view.
Thus, utter confidence in the breast surgeon and his/her team is imperative to the coping style of a young woman at a time when she feels completely in shock, overwhelmed and as if life has dealt her a cruel blow.

MOTHERHOOD AND BREAST CANCER

Many young women diagnosed with breast cancer have dependent children - school age or below - to consider. Others considering having children may have their dreams dashed as a result of chemotherapy-induced infertility or early onset menopause caused by cancer treatment. Very rarely but potentially devastating are cases of women falling pregnant and having a diagnosis of breast cancer which can put both mother and foetus at risk. For a long time, it was assumed that chemotherapy was dangerous to the foetus but several recent studies have found that using certain chemotherapy drugs during the second and third trimesters does not increase the risk of birth defects. Because chemotherapy and hormone therapy drugs can enter breast milk, breast feeding is usually not recommended.

Despite the huge assault to their fertility caused by harsh chemotherapy drugs, some young women do go on to have more children.

ISOLATION ISSUES

Because so few women under the age of 40 get diagnosed with breast cancer, many young women can feel incredibly isolated. Young women face unique challenges not always experienced by older women. Feelings of isolation can lead to depression, despair, anxiety, a sense of being ‘singled out’ for adversity, and guilt, punishment and helplessness.

SUPPORT

Support, education and resources are the best friend of a young woman recently diagnosed with breast cancer.

Although breast cancer usually results in initial unpleasant medical interventions, it is important to realise that a woman’s support network and ‘coping style’ can improve her overall quality of life.

Emotional recovery from the trauma of cancer takes longer than the physical recovery. Healthy attitudes and beliefs do improve physical outcomes and the ability to cope with adversity.

Other breast cancer survivors play a crucial role by demonstrating that they are still alive, coping well, have retained a great sense of humour and are in control of their lives. It is important for young women to give themselves permission to take strength from others as a coping mechanism at a crucial time of loss in their lives.

Counselling from a skilled therapist or a clinical psychologist who works in the area of oncology can be useful in teaching a young woman techniques such as anxiety management, slow breathing, how to reduce catastrophic worry, how to control negative automatic thoughts, how to stop worrying about what you cannot control and how to embrace a positive coping style. Counselling that focuses on grief issues is also comforting and healing.

As well as professional counselling (if appropriate) surrounding oneself with friends, support and humour are also essential mechanisms for developing a positive attitude and purpose in life.

The importance of a positive coping style, a fighting spirit and resilience are now well documented. Taking strength from other breast cancer survivors, sharing experiences of hope, fear, laughter, anxiety and a determination to live life to the fullest is essential. Support from other cancer survivors is the best strategy a young woman can use in her fight against breast cancer.

By Maureen Trainor

Maureen Trainor is a registered Clinical Psychologist with 20 years experience who operates a private practice in Hamilton. She has a special interest in the area of oncology, especially breast cancer. Maureen is a two time survivor of breast cancer and a strong advocate for increasing the quality of life for women with breast cancer.
References

Cancer New Registrations and Deaths 2005, NZ Health Information Service, 2008.
Organisation for Economic Cooperation and Development, 2007.